title: Bacteriologic epidemiology and empirical treatment of pediatric complicated appendicitis.
abstract: Preoperative samples in the context of complicated appendicitis (CA) are rarely collected, and there is no consensus regarding the optimal antibiotic therapy in children. To help optimize empirical preoperative treatment, we studied clinical and bacteriologic data from a prospective cohort of 93 children with CA in a French hospital. All the bacteria isolated from peritoneal fluids were identified, using phenotypic and/or molecular techniques. The most commonly recovered species were Escherichia coli (71%), Streptococcus group milleri (34%), anaerobes (20%), and Pseudomonas aeruginosa (19%). The association piperacillin-tazobactam is an accurate choice of empirical therapy as it is active against 97% of bacteria. A third-generation cephalosporin with metronidazole in association with an aminoglycoside is a good alternative. Although antibiotic use may be considered as an adjunct to surgical intervention of CA, the appropriate use of preoperative antibiotics is essential and must be constantly reevaluated according to the bacterial epidemiology.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, Laboratoire de Microbiologie, Hôpital Necker-Enfants Malades, Paris 75015, France.
authors.forename: Christelle
authors.initials: C
authors.lastname: Guillet-Caruba
authors.forename: Alaa
authors.initials: A
authors.lastname: Cheikhelard
authors.forename: Marlène
authors.initials: M
authors.lastname: Guillet
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Bille
authors.forename: Philippe
authors.initials: P
authors.lastname: Descamps
authors.forename: Lin
authors.initials: L
authors.lastname: Yin
authors.forename: Naziha
authors.initials: N
authors.lastname: Khen-Dunlop
authors.forename: Jean-Ralph
authors.initials: JR
authors.lastname: Zahar
authors.forename: Sabine
authors.initials: S
authors.lastname: Sarnacki
authors.forename: Yann
authors.initials: Y
authors.lastname: Révillon
authors.forename: Patrick
authors.initials: P
authors.lastname: Berche
authors.forename: Agnès
authors.initials: A
authors.lastname: Ferroni
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D001064:Appendicitis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D001202:Ascitic Fluid / Q000382:microbiology; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008826:Microbial Sensitivity Tests; D011300:Preoperative Care; D034364:Streptococcus milleri Group / Q000187:drug effects / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents